Title of Course: The Grieving Self
CE Credit: 3 Hours
Learning Level: Intermediate
Author: Joan P. Hubbard, MA, LMFT
Abstract:
The annual number of deaths reported in the United States in the early part of this century was 2.4 million, about four
per minute. The Grieving Self looks at the stories of a few of those who are recently bereaved to determine the major
issues for those who grieve: aloneness, loss of self, social connections, anniversaries and holidays, self and others’
expectations, the need to continue living, ambivalence of recovery, grief dreams, and medical problems. Studies are
reviewed which indicate some researchers’ conclusions as to: 1) gender differences between men and women who
grieve, and 2) who among the grief survivors are best served by counseling and psychotherapy. The author, while
agreeing with much of the research, challenges the belief that the emotional loneliness suffered by the bereaved is
the single, major dynamic of the bereaved, and can only be alleviated through passage of time. It is felt that an effort
to reconnect those who grieve to a stable sense of self can help the bereaved regain better function and reduce the
length of the time they are consigned to painfully distressing lives.
Learning Objectives:
1.
2.
3.
4.
5.
6.
7.
Identify common reactions experienced by those who lose a close, personal relationship
Differentiate between the characteristics of grief’s first and second stages, as described by the author
Identify strategies for educating clients about the grief experience and how to develop a recovery plan
Identify those clients who might fall into the category of “chronic grievers”
List the differing patterns of bereavement behaviors exhibited by individuals who are grieving
Describe how the Myers-Briggs Type Indicator (MBTI) can be used to work with issues of self
List strategies therapists can use to help clients reclaim an operational self
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The Grieving Self
Introduction
Grief is a journey most of us are destined to take. We will experience grief at a loss of our physical parts or the abilities
of our bodies to perform, the loss of important relationships (family or friends) through death or attrition, loss of jobs
and opportunities…loss of some aspect of what we know to be our self. Grief is our individualized effort to mourn and
recover from assaults upon our self.
The self is the sum total of all that we know of who we are; the loss of any part of this package creates a hole in the
system. The size of the hole is a reflection of the importance of the lost piece. This hole must be “refilled” and
“reshaped” before we complete the major part of the grief process. We may never be far from the pain of the loss;
however, as we refill and reshape the hole with new activities and abilities, we create a new path toward a viable life.
Most do create the new path; some, however, never seem to recover, never seem to be able to refill or reshape the lost
part of self. Those who have a fragile or incomplete sense of self are most at risk of becoming adrift…seemingly losing
their ability to create a new path. It is as though the lost piece had been their self definition. Without that piece, the self
has no functional existence, no aptitude for, or interest in self-repair.
A major loss such as a long-time marital partner, a child, or a truly close family member can create tremendous upheaval
in our self system. Think back to adolescence when our bodies were growing in uneven ways, our skin was breaking out
as hormones hit the system; many new opportunities (both positive and negative) were available to us. That time of life
was, typically, full of emotion as waves of the unexpected washed over us. Prior to our experience of grief, this was
probably the most disorienting period of time for the self. Several years were required before the self coalesced into an
altered, but smooth-working system.
This also appears to be true for the recovery from grief, an event that provides a major assault upon the system. It is as
though a big hole has opened up in a well-traveled path with no way to pass the spot until some repairs are made. At a
time when one is reeling at the unexpected appearance of the huge hole, accompanied by overwhelming feelings of
loneliness, anger, and disorganization, one is simultaneously being urged to make one’s way to the other side in order to
continue the journey. Offers of help are generally forthcoming, but from caring persons who know nothing about how to
fill the deep, personal hole. Those deep, personal holes have to be filled, over time, by the person who experiences
them. How, then do we assist ourselves or others to fill this deep, personal hole?
Chapter 1: The Event – First Stage of Grief
Unexpected Death
Jennifer’s story is an example of an unexpected death. Jennifer and her husband, Bart, had enjoyed 37 years of marriage
when he died suddenly, and to Jennifer, quite unexpectedly. Bart had been suffering with heart problems for the
preceding four months. He had made many weekend trips to the hospital, but each time he and Jennifer were reassured
that he was basically healthy and would recover. Bart’s doctor prescribed physical rehab, but he was having a difficult
time following through because of general weakness and continuing nausea. He was also suffering from some anemia or
blood loss, which required blood transfusions. Because his physicians did not want to do the testing to determine the
cause of the blood agenda until Bart was in better health, this symptom was just treated by the blood transfusions. The
couple once again made the journey to the hospital the last weekend in October 2008. This was Bart’s last trip to the
hospital. He went into a crisis while there and was immediately moved to ICU. Jennifer was asked by a doctor on duty at
this time if she wished to have him resuscitated. She was horrified and replied, “Yes, of course.”
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Bart’s physical state continued to deteriorate until his death on Monday, October 27. In retrospect Jennifer discovered
that a scan had been done on the preceding Friday, the results of which showed multiple lesions in Bart’s internal
organs. But Bart’s physician was not there to provide this feedback to the couple, so neither of them realized until the
crisis that Bart’s time was very short. What actually took Bart’s life was the spread of colon cancer. Jennifer was
stunned. Bart had been under the care of physicians at one of the nation’s top medical facilities. How could such a thing
happen?
Jennifer was left feeling a great loss at not having had an opportunity to say “Goodbye,” at not having the opportunity to
tell Bart once more how much she loved him, and to also hear these words from him. In addition, there was anger that
the doctors had missed the most important part of the diagnosis and then, when discovered, were not there to transmit
the new information to Jennifer and Bart. On a more practical level, they never had the opportunity to talk about his
impending death in terms of how to access financial records, where to find important policies and records. To Jennifer it
felt as though Bart had been snatched away from her with no warning.
This couple, Jennifer and Bart, had raised their family in their present community, had both been professionally
successful, committed members of their church and involved in many community affairs. Jennifer had many support
systems in place; however, a large part of who she was, the self she would describe up to the point of Bart’s death, was
now different…not only different, but unfamiliar and unknown (personal conversations,
2008).
Joan Didion (2005), in her prize-winning, non-fiction account of her husband’s death, has
written a theme statement which appears throughout her book, “You sit down to dinner
and life as you know it ends.” John Gregory Dunne, Didion’s husband of 40 years, died of
a massive and fatal coronary event as he sat down to dinner in their New York apartment
in December 2003. The couple had just returned from visiting their critically ill daughter
who was in the hospital. The Year of Magical Thinking (2005), Didion’s book, is her
attempt, “to make sense of the period that followed, weeks and then months that cut
loose any fixed idea I had ever had about death, about illness, about probability and luck,
about good fortune and bad, about marriage and children and memory, about grief,
about the ways in which people do and do not deal with the fact that life ends, about the
shallowness of sanity, about life itself” (page 7).
Initial Impact on Survivor
Both of these widows report a short period of time following the deaths of their spouses, which they had anticipated to
be the most difficult, but which was actually more of a period of suspended animation, a time when the idea of their
husbands’ death was not yet real. This was also a time when support from family, friends and professional relationships
was at its peak providing constant support. Although there are, initially, a bewildering number of things that must be
done, people start showing up to help. There is some relief in having competent people close by to help guide and direct
the activities that need to be happening. However, a major ambivalence appears for Didion (2005): at a time when she is
faced with the need to plan a funeral, create an obituary and begin the process of providing the family, friends and
community a chance to say “goodbye,” there is a reluctance to move forward with these plans because that is an
admission John is dead. And that death is not yet real for her; in fact, at this stage his death still appears reversible.
Concurrent with her husband’s death Didion was also at her hospitalized daughter’s bedside, not knowing whether the
daughter (Quintana) would live or die. Didion could not plan a service for John until Quintana was out of her coma and
able to help plan and attend the service. Finally, on March 23, the memorial service was held and John’s ashes were
placed in a chapel off the main altar in the Cathedral of St. John the Divine. The next day, almost three months after
John’s death, Didion relates, “I put away the plates and allowed myself to think for the first time about what would be
required to restart my own life” (p. 86). She began the “first day of the rest of my life” by cleaning her office. She felt she
had come into a new season.
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Violent and Unexpected Death
The intimations of disaster arrived via a telephone call from the police asking of Aaron’s whereabouts. Aaron was
attending a small Catholic college and living in a house with two other young men, Brian and Andrew. Aaron and Brian
were missing. The third young man, Andrew, had awakened early in the morning to the sound of noises downstairs. He
had known something was wrong and had jumped out of his bedroom window. Looking into the downstairs window, he
had seen a man with a white handkerchief tied around his face.
Andrew was spotted by this man who yelled, “…there’s another one.” Andrew ran to the nearest neighbor’s house to
call the police. When he returned, no one was in the house and Brian’s car was gone. The car was later spotted and
stopped by the police. Both men fled but the police were able to apprehend one of the men. This was on a Tuesday. On
Wednesday, the police arrested the second man who had been part of the break-in at the boys’ house. Thursday…the
investigation continued. Friday the family were notified by the police that, “We found Aaron, and he is deceased.”
Brian’s body had also been found near that of Aaron’s (O’Hara, 2006, p. xxvii).
Initial Impact on Survivor
This mother, like the widows, finds the next several days somewhat fuzzy. “I don’t remember the next two days very
clearly, I knew only that Aaron was gone. I was borne up in the stream of events by what I can only describe as grace and
support. I walked, talked, made decisions, yet was numb and frozen inside, unable to decipher the meaning of what had
just happened. I moved through the world in a dreamlike state, unsure of everything” (O’Hara, 2006, p. xxviii).
Suicide
The phone call came early on a Sunday morning while I was fixing breakfast for our bed and breakfast guests. The caller
was the woman who came in for about four hours at the beginning of each day to care for my mother. Although Mother
did quite well following her stroke, this caretaker helped her with cooking, bathing and chores. She was also available to
transport Mother for appointments and errands, as she could no longer drive. The caretaker asked to speak to my
husband, who was not available. She was unwilling to tell me what had happened (no doubt the result of a training
program). I could not get her to tell me whether or not Mother had suffered another stroke or whether or not she had
died. I was furious that I had to leave the phone, go locate my husband and get him to the phone so that he could
translate for me whatever tragedy had occurred.
Apparently, when the caretaker arrived that Sunday morning, she discovered Mother in her car inside the garage with
the motor running. The house and garage were full of carbon monoxide. The caretaker had called 911 and police and
paramedics were there at the time I arrived. Initially I was not allowed to see Mother, but was able to see her before she
was removed from her home. She did not look dead…she looked only like she was sleeping. I gave her a kiss. The
numbness was overtaking me, but I didn’t blame Mother. As I told the police, “she hated her life.” My mother, who had
been a very independent person, found her current state of dependence extremely distasteful.
Initial Impact on Survivor
In the midst of the unreality of Mother’s death…death by her own hand, I was faced with the necessity of dealing with
police and their need to ask questions and collect information. It is difficult to recall exactly how things developed after
that. I believe I went to my daughter’s home a short distance away, where my husband joined me. Phone calls needed to
be made and someone did that for me. My husband took me to the funeral home, even though it seemed too soon to be
doing this. The funeral home gathered information for the Obituary and made plans for her service. I was trying very
hard to follow the instructions Mother had previously discussed with me, and also left in writing in her living trust. As I
write this, I recapture the sense of a heavy, fuzzy brain, a feeling of being disconnected from my usual state, a great
sense of sadness. One can perform in this state, but one does not initiate action. It is the help, the support and guidance
of others that make things happen.
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Terminal Illness
Sandy Broyard, a psychotherapist, writes of the experience of her husband’s death from cancer (Broyard, 2005). The
pain of her experience precedes the actual death of her husband as she witnesses the death of individual functions and
capacities of the husband whom she has known and loved for 29 years. Although there is certainly a time of death, 6:00
AM, October 11th, Broyard’s recounting of the time leading up to his death is so full of pain and distress that there
appears no clear delineation of death as a new place to be. She reports that until a week before her husband’s death she
continued to hope that he would live. Her “transition from hope to knowing Anatole was dying” occurred in a
conversation with the surgeon who had recently operated on him. The doctor, who had several weeks earlier performed
emergency surgery to provide a few extra weeks of life for Anatole, came to tell Broyard that Anatole was now dying.
Broyard recalls that day when her husband’s bladder burst, and she was told that he would be dead in a matter of hours
without surgery. She relates that she “couldn’t let Anatole die that day.” The surgery was performed September 10,
providing Anatole about four additional weeks of life.
Initial Impact on Survivor
Broyard’s account of Anatole’s dying does not reveal much of the time that surrounds his death and cremation. It is as if
the pain and unreality actually began during the latter stages of his illness, and his death does not become truly real until
his burial in July. Broyard does reflect upon what she considers to be her lapse in not furnishing clothes for Anatole’s
cremation. She remembers how important dressing well was to Anatole and feels she failed him by not thinking to
furnish clothes for this, his final appointment.
The burial of Anatole’s ashes was planned for his birthday, July 16. Prior to this date, the ashes remained on a pine
bureau in their Cambridge home. So it is that at eight months and four days after Anatole’s death Broyard records, “I am
alone and empty in a way that I wasn’t before. It’s as if I’m beginning to wake up to the reality of my new life and it
frightens me” (p. 30).
A Common Thread
These five stories are just a few of the many that have been written about the loss of a significant person in one’s life.
Although death is a common tragedy, felt by many in everyday life, the impact of this loss is not to be underestimated.
The loss of this important “other” can be completely disorganizing to a person experiencing the loss.
Over time the person we are, the self, has merged that significant other into our own identity. The loss of that other
makes a tremendous impact on our individual self. A marriage of two independent identities, “you” and “me” has
created a third identity of “you and me” (the interdependence required to live together). The long-term, fulfilling
marriage is a result of having effectively worked out an accommodation to bring the differences into a workable
whole…a whole new identity. Now a large part of that whole is gone. As Didion (2005) continued to reflect throughout
her lament, “You sit down to dinner and life as you know it ends.”
The loss of a child has all those same dimensions with some added ones: the child most often is a product of our own
DNA, or in some instances, becomes ours after a lengthy process of adoption. The child – from the first moments of life
– has demanded that we reorganize ourselves to accommodate his/her needs; giving birth to, or adopting this child has
required that we accept the responsibility of providing the nurturance and safety to bring this new life to maturity.
He/she is very much an inseparable part of our identity. One parent’s observation was that in “early grief ‘bereaved
parent’ was our identity. We wore it as a badge; we were bereaved and little else defined us. Thankfully, that has
changed with time” (Mitchell, Barkin, et. al, 2004, p. 49).
Regardless of how this important “other” is related to us, the first stage of grief finds us numb with shock. The reality of
the death is still a fog-bound happening; the reality comes as we slip into the second stage of grief.
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Chapter 2: Internalizing Reality of the Loss – Grief’s Second Stage
This stage of grief usually appears close on the heels of the numbness and disconnection one experiences at the initial
loss of a spouse, child, parent or other close, family member. This is the period of time which Didion (2005) describes, “I
realized through the winter and spring I was incapable of thinking rationally. I was thinking as small children think, as if
my thoughts or wishes had the power to reverse the narrative, change the outcome. This continued from December 31,
when the first obituaries appeared until the night of the 2004 Academy Awards, when I saw a photograph of John in the
Academy’s ‘In Memoriam’ montage. When I saw the photograph, I realized for the first time why the obituaries had so
disturbed me. I had allowed other people to think he was dead. I had allowed him to be buried alive” (p. 35). The 2004
Academy Awards were held February 29, following John’s death on December 30, 2003. This is a full two months
following John’s death that Didion has resisted internalizing the fact that he is truly gone.
Didion continues to elaborate on this period of time as she describes her attempt to give away some of John’s clothes.
She had been encouraged by well-meaning friends to do this. Although she was not prepared to give away “his suits,
shirts and jackets,” she believed she could deal with his shoes. But she found she was unable to give away his shoes. “…I
stood there a moment, then realized why: he would need shoes if he was to return.” Didion continues, “The recognition
of this thought by no means eradicated the thought” (p. 37).
She writes of what she and other people believe about grief before they have
experienced it, “We imagine that the moment to most severely test us will be
the funeral, after which the hypothetical healing will take place. When we
anticipate the funeral we wonder about failing ‘to get through it,’ rise to the
occasion, exhibit the ‘strength’ that invariably gets mentioned as the correct
response to death. We anticipate steeling ourselves for the moment...We have
no way of knowing that this will not be the issue. We have no way of knowing
that the funeral itself will be anodyne, a kind of narcotic regression in which
we are wrapped in the care of others and the gravity and meaning of the
occasion. Nor can we know ahead of the fact (and here lies the heart of the
difference between grief as we imagine it and grief as it is) the unending
absence that follows, the void, the very opposite of meaning, the relentless
succession of moments during which we will confront the experience of
meaninglessness itself” (p. 189).
Broyard (2005) reflects on the time between October (Anatole’s death) and
April. “The amazing thing about grief is that it doesn’t hurt all the time” (p.
13). She later states, “When I don’t cry I am beyond tears in a place where
there is no emotion. The degree to which I miss Anatole is so great that tears and sadness have no relationship to the
void that is my life now. Tears are for something specific. Losing my husband is like losing who I am” (p.17).
Particularly during these early months of loss, Broyard, in her solitude, reviews the latter stages of Anatole’s illness.
After his final surgery in September before he died in October, she realizes that she had just been glad he was alive; but
now she wonders, “…where was he? Where was his brain? Could he still dream? Where was his soul?” (p. 19). “…For his
sake I don’t want to erase the sharp edges of his purgatory. I am his amanuensis. My job is to testify, to report, to tell
others about his suffering and the ravages of the cancer. What it did. Why it was so terrible” (p. 20).
“When I am thinking about Anatole and his illness, I feel I’ve come back to myself, that I’ve returned to my life. Escaping
doesn’t work” (p. 20) “Whatever sense I have for the future lies outside of myself. A new garden, a new job. Those
things I can see, but inside myself and my home there is chaos” (p. 26). Broyard’s self is so dependent upon Anatole that
she needs to reside in that awful time of his illness to be able to reconnect with her recognizable self. Moving forward
will require a redesign of self.
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For Jennifer, who unexpectedly lost her husband to cancer, the months following Bart’s death were full of the
overwhelming requirements to do the multitude of things that needed to be done: locating important paper work,
insurance policies, financial records, bank accounts, and having to face the fact that she did not know how to perform
the tasks that needed to be done; the exhausting effort required for trying so hard to be cheerful; the difficulty of
finding other persons to be part of her social environment. Bart had been her companion through the mundane,
everyday rhythm of life, as well as the special moments between husband and wife. It was a totally incomprehensible
task for Jennifer to figure out how she could construct a social environment that would provide ready social interaction
throughout the seven days of the week.
For me, following my mother’s suicide, I continued to revisit the reason for her need to kill herself. That phrase, “kill
herself” seems so harsh…it is hard to write, but it is the fact I need to accept. There was much private reviewing of our
last times together, our conversations…and the realization that I, a psychotherapist, missed the one clue she provided.
The Saturday before her death (which occurred early the next morning), we had enjoyed a really upbeat telephone
conversation. I had felt so relieved to hear what I perceived as her having turned a corner, as having hope for the future
times we would enjoy together. Reflection indicates this is the altered emotional state following a decision by a suicidal
person to end her life.
The year following Mother’s death was intensely difficult. We had been such good friends for the 63 years of my life.
When something nice was happening in my life, a piece of good news, or perhaps bad, I had picked up the phone and
shared that bit of information with her. For months following her death, I would find myself picking up the phone to call
her. A close friend of Mother’s often dreamed of her; I did not dream of her, but wanted to very badly. Over the course
of the nine years since Mother has died I have had three dreams of her which I could remember upon waking. I have
awakened some additional mornings when I felt that I might have dreamed of her, but with no clear recollection of the
dream. Throughout the first year following her death, the major holidays, plus her birthday were particularly painful.
Thanksgiving was her favorite holiday and she liked to have the Thanksgiving dinner at her house. Since her death, I have
tried to be the family hostess on that day. With Mother’s death, I have lost a vital connection…to her, to my history and
to the history of our extended family.
With the death of an important person in our lives, we cannot be who we were prior to the death. I can no longer look
to her for a perspective different from my own. I am no longer anyone’s child. I have become the family matriarch and I
was not ready.
O’Hara (2006), a psychotherapist who lost her college-aged son to a violent death declares, “It is important to remember
who you were the day before the event happened. When you are faced with these violent events, you lose the
connection with your immediate sense of self – your place in a world larger than the immediate circumstance” (p. 20).
She cautions, “This grief of yours is not something that can be neatly packaged into a predictable measure of time. Grief
is a powerful process that affects each person differently. You cannot get over it just so others can feel comfortable.
Grief is often unrelenting, disruptive and ever-present, but it will get better” (p. 92).
“Tidal waves of emotion” is the metaphor O’Hara uses to describe the strong emotions
that suddenly appear and wash over the bereaved. These emotions seem to come out
of nowhere; however, they come from within each of us as we struggle to cope with
our loss: extreme sorrow and pain, confusion, guilt, ‘crazy’ feelings, loneliness, fear,
anger, etc.
Pursuing this same thesis, O’Hara relates her own experience of overwhelming emotion as she moved into the reality of
her loss, as the numbness and shock of Aaron’s death began to recede. She named the onrush of feelings, “the
torturers;” she felt she needed to name them in order to manage them. As she allowed the torturers to find her, gave in
to feeling the pain, she found the feelings did not destroy her. “And so, I allowed grief to do its work. Not because I
wanted to but because I had to. The torture was coming from within and it was my job to let it out” (p. 93).
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Addressing the state of “craziness” that many who grieve feel they are exhibiting, O’Hara reassures the reader this is a
normal reaction for one who is experiencing a catastrophic loss event. She reminds her readers that, “…love for the
person who is gone has not ceased with that person’s heartbeat. Whenever you wonder if you have lost your mind,
remind yourself: you have lost someone you love, not your mind” (p. 99).
There is a need to rebuild one’s life following a catastrophic loss, but it is not possible to rebuild it as it was before the
loss. O’Hara believes, “…you will rebuild a world that will be an integration of what once was, what it is now, and the
possibilities for the future” (p. 174).
As these survivors describe their experiences of the second stage of grief, it is easy to identify their theme: lost self. The
question they are seeking to answer is, “Who is this Me without Thee?”
Chapter 3: Issues of Grief’s Second Stage
Aloneness
After the initial stage of grief, when others are physically close to assist the grieving survivor, comes the absolute
stillness of loss. Suddenly all the tasks created by the death must be confronted within the framework of an empty
house. For the spouse of a long-term marriage, the loss of the easy companionship of the spouse is crushing. The loss of
one who shares the same social connections, experiences, memories, who has danced to the same music, is
unfathomable. How does one keep going in the face of such loss? And the continuing question is, “Who am I without
you?”
A long-term marriage stands as an example of the effort a couple makes to accommodate the individual differences
each brings to the marriage. A long-term marriage becomes three identities: you, me and us. You and me, of course, are
the two independent identities who, together, create the interdependent identity of “us.” Over the years, the
interdependent identity of “us” has the largest investment of time and energy. When a partner of the “us” dies, there is
a huge hole in the self system of the survivor. The way we think of ourselves and experience ourselves is severely
challenged. Because their words are so powerful, I have chosen to let two of the authors tell you themselves of their
experience with this aloneness.
“Husbands walk out, wives walk out, divorces happen, but these husbands and wives leave behind them webs of intact
associations, however acrimonious. Only the survivors of a death are truly left alone. The connections that made up
their life – both the deep connections and the apparently (until they are broken) insignificant connections – have all
vanished. …We are repeatedly left, in other words, with no further focus than ourselves, a source from which self-pity
naturally flows. Each time this happens (it happens still) I am struck again by the permanent impassibility of the divide”
(Didion, 2005, p. 195).
She continues, “Marriage is not only time: it is, paradoxically, the denial of time. For forty
years, I saw myself through John’s eyes. I did not age. This year, for the first time since I
was twenty-nine, I saw myself through the eyes of others. This year for the first time since
I was twenty-nine I realized that my image of myself was of someone significantly
younger” (Didion, 2005, p. 197). She reflects on their having lived and worked together
within their own home for all but five months of their forty-year marriage. She comments
upon the number of times every day she and John would spontaneously interact: she
would have some urgent news to relate, something interesting to share with him, some
plan to be made, etc. Now, “There is no one to hear this news, nowhere to go with the
unmade plan, the uncompleted thought. There is no one to agree, disagree, talk back.”
Didion (2005, p. 194-195) has described quite vividly the degree of merged identity that comes through many years of
living together...and the depth of pain and confusion caused by the sudden loss of half of her self.
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Broyard (2005, p. 64) speaks of her inability to sit at her desk… “Because invariably there is a scrap of paper that pulls
me back to the place from which I watched my husband die.” She continues, “To watch someone die is a terrible
experience. It fills one with dread, and after the person dies, the dread remains. It carves out a space inside of you and
settles in for the long haul. The dread saps your energy, leaves you inert.
“I have always been independent and have done lots of things alone and am content with my own company, but to be
alone when you know that somewhere there is another heart, another being that is a familiar part of your life is very
comfortable. Then it’s a choice or a plan to be alone. Perhaps something needs doing that’s better done alone, a chore,
a project. But to be alone because there is no one else in another room, another town, another place who occasionally
thinks of you is to be alone in a random unconnected way. To be alone like this means a life or a day with no edges. If I
get home late or I don’t get home at all, who will notice?” (Broyard, 2005, p. 87).
This aloneness described by Broyard is also the aloneness that Jennifer fights. Although she had much alone time when
Bart was alive, it was by choice and there was a time she could count on when she and Bart would physically reconnect.
That reconnection is no longer possible…and never will be again. “Never” is a very long time.
The sudden move from being one of a regular twosome to becoming a single, “one-some,” impacts every facet of life.
Everything has to be rethought. According to Strobe et al (2005), “the most common emotional difficulty suffered by the
bereaved is emotional loneliness: the missing of the deceased and the feeling of being utterly alone, even when in the
company of friends and family.” The authors continue, “It is possible that this type of loneliness only abates with time
and that nothing can be done to further the recovery process” (p. 409).
Social Connections
Typically, after the initial shock of a death and the funeral, family begins to return
home and friends return to the rhythm of their own lives. The partner or parent is
then left with all the legal, financial and logistical requirements of losing their
spouse or child. The grief survivor is also left with a major hole in their lives to face
on a minute-by-minute, hour-by-hour, day-by-day basis.
If family is locally available, they usually stay more closely attached for some
additional time. Close friends will also continue to check in with the survivor;
however, with the passage of time everyone, with the exception of the grief
survivor, returns to the demands of their own lives. The survivor is left to determine
how to deal with the difference in the requirements of his/her own life. The way a day begins and ends and all the time
in-between now has to be faced without the lost, loved one. The routine of many years is no longer valid or useful. The
survivor will have to construct a new plan for living. What to do about breakfast? ...about chores?...about social
connections? What chores are no longer needed? Where to go alone? How to develop new opportunities for
companionship and shared experience? How to fill the empty spaces in their lives?
Jennifer, who had spent hours painting in her home studio, found after Bart’s death, she could no longer tolerate the
aloneness of the endeavor. Her emotional well-being was better served by getting out of the house and staying busy.
She went back to working with the Department of Education in a small college, supervising students in field placements.
She began to reconnect with some of her old friends in the teaching field, for lunchtime get-togethers or other social
opportunities.
Jennifer has also made efforts to hold onto the close relationship that she and Bart had enjoyed with two special
couples. Because she does not want to lose contact with these two couples, she invites them to dinner about once each
month, and continues to seize other opportunities to interact with them as individuals or couples. But all these activities
are planned efforts, which take time and energy. She has confessed to becoming occasionally exhausted with the
requirement for this much effort to create social interaction.
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One of her strategies to face a new day is not to leave her bed in the morning before she has answered three questions:
1) What’s today?
2) What do I need to do today?
3) What can I do today?
Answering these questions focuses her on some forward movement as she begins the process of facing each new day
alone.
The art world has been a natural resource for Jennifer through the friendships developed while attending art classes and
art shows. She still does very little painting at her home alone. Now, fourteen months since Bart’s death, Jennifer has
found a way to begin painting again…she has found an artist’s studio in an art cooperative. This spot will be a place she
can paint amongst others who are also working on their art, a place she can hang her own completed artwork and have
the camaraderie of other artists in the area. She has begun and continues the re-structuring process for her self.
An ongoing problem, however, is the close of each day and the weekend, particularly Sunday. Although she has found
ways to fill many of these hours, it is still difficult to be so alone. Broyard’s experiences concur with those of Jennifer.
Broyard muses, “Without Anatole, without my husband, the sadness tells me, reminds me that I’m alone, cast off, on a
solo voyage now. Every night, every end of the day is a solitary time. Every morning, every awakening is only to my own
thoughts, my own questions, my own lack of answers” (2005, p. 173).
Broyard also observes what she calls the being “winnowed or widowed out of the couples’ world I used to know” (2005,
p. 103). The single widow simply does not fit into the couples’ culture, a culture that is no longer available to the
bereaved man or woman. This time of grief is a very strange time during which the recently bereaved have no culture of
his/her own.
In addition, Broyard observes, “I am different now. I know it, and others are just beginning to sense it. Stronger, wiser,
smarter, I know things they don’t. I’ve seen things they haven’t seen. I’ve persevered. I’ve endured and they don’t quite
know who I am. I’m not quite sure myself” (2005, p. 103). So how do friends find ways to relate to this now single person
who is behaving in ways which are increasingly unfamiliar? Or do they just stop trying?
Anniversaries and Holidays
Grief survivors have an extremely difficult time during the first year after their loss. There is
no way of avoiding the first birthday of the deceased, nor the first Thanksgiving, nor the
wedding anniversary, nor Christmas or Jewish holidays, nor any of the special days that the
family has typically celebrated. Only, for this first year, there is a painful awareness that their
loved one is no longer with them. These times require special planning by the survivor(s) to
avoid falling into an unexpected emotional hole. Jennifer’s family got together on Bart’s
birthday to have dinner at one of his favorite restaurants, and raised a toast to him. This did
not avoid sadness and feelings of loss, but it marked the day as special to the whole family
and provided support to all members.
Anniversaries of the death are also extremely difficult to face. Some survivors start out by
having a weekly anniversary of their loved one’s death, the day of the week the death
occurred …one day each week that is almost impossible to endure. Other survivors are faced
with the painful reminder of the loved one’s death on the monthly anniversary date. However, a survivor tends to mark
the remembering of this awful time when the loss actually occurred, it is an emotionally difficult period. Survivors need
to make plans for these anniversaries…plans that help cushion the loss. It might be important to have other family
members or close friends as a support during the early stages of grief. Gradually, as time moves on, the survivors can
look ahead to these days and plan to be involved in some activity that protects them from being alone to brood.
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O’Hara (2006) tells the story of Sharon and her remembrance of the first year’s holidays, “I barely remember the first
year of holidays; I think I just white-knuckled it and muddled through. Much of what I did was for my children, so they
might have some sense of the holiday, but I think they, too, were in shock, and we all just passed the time. It was such a
relief when it was over” (p. 163).
The first year, so full of anniversaries of loss, is traumatic. There is no magical way to avoid any of these dates. The
survivors, first with the help of others, then accepting that responsibility for themselves, must plan strategies for getting
through these anniversaries. The following years tend to be, gradually, a bit easier.
Self and Others’ Expectations
Those who are grieving a major loss frequently find themselves embarrassed at their continuing grief. They perceive
others’ discomfort around their sadness and distress, and work very hard to contain their grief so others are not
discomforted. They, themselves believe they should be better after a few months. Tagliaferre and Harbaugh (2001)
point out that, “Heart-attack victims and surgical patients may be allowed by employers several weeks or even months
to recover, but mourners are expected to be at work and back on the go in a week or so” (p. 8). As these authors point
out, psychic wounds are not visible like physical trauma and are thus provided little time or sympathy from established
institutions.
Ott et.al. (2007), a bereavement study, includes a definition of common grief that suggests recovery is expected to take
anywhere from months to several years. The time-line is a very personal one. Broyard (2005), in the account of her own
grieving, reports a period of 5 ½-6 years as her personal journey through grief.
It is unlikely that anyone who has a close connection and shared identity with a significant other is going to recover in
less than a year, and it will probably be another year or two before they have re-engineered their new self to the point
that it feels like life can be rewarding and can offer additional possibilities. Even then, there will still be times of sadness
and yearnings for the deceased.
Parents who have lost children claim that this loss is the most difficult of all and report that it takes years to recover.
One group of women who met through a bereavement group and bonded through the loss of their children decided to
collect and write their stories as a memorial to their lost children. The stories were told to Ellen Mitchell who compiled
and authored, Beyond Tears (2004) as their memorial.
As they met to discuss their stories the question was asked, “Was the first year the worst? We sat and dissected that
question and we cannot agree on one definitive answer. We do concur that we were in shock throughout these first
twelve months and it cushioned some of the pain, which we later felt more acutely. However, we also know that
eventually the horrific pain began to ebb for most although not all of us. Over time, we have been able to cast off some
of the agony and disbelief and accept the fact that our lives continue, although in a vastly altered state” (p. 23).
Speaking to the length of time it took the mothers to recover from the death of their children, Mitchell (2004) reports,
“In the fourth year after Michael’s death, Ariella suddenly found herself listening to music. Some time after Lisa’s death,
Carol started volunteering as an advocate for foster children. Rita found new meaning in her life by nurturing her
students. Audrey is sustained by giving of her time and love to two boys from impoverished circumstances. Barbara
Goldstein sold her home and moved closer to her two surviving sons. We went on vacations, we colored our hair, we
began to let light back into our shadow existence” (page 87). These mothers were recovering, but they make the point
that it is a long, painful journey back to being able to perceive a future. It is interesting to note that a return to living
seemed to be composed of behaviors that were meaningful to the mothers and generally, helpful to others.
Regardless of the author who is writing about the grieving process, each points out that the recovery is much more
difficult and over a much longer period of time than they would have anticipated.
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The Need to Continue Living
The loss of a loved one that creates a major assault upon the self frequently leads to a loss of caring about one’s own
living. The thought of a future is only an indicator of more pain to be experienced in a world that can never be “right”
again. There is a total inability to conceptualize anything beyond that which is currently being felt. There is no hope.
Tagliaferre (2001), relates his perception following the death of his wife, “There was no comfort anywhere as I searched
in vain for a place I belonged where I would feel whole again. If you are like me, you may feel there is no such place.”
Or Jennifer, who replied to a conversation about the hope of feeling better in the future, “I understand what you are
saying about the future. Maybe someday I will believe it and feel differently. Right now, I just can’t accept that it will be
anything but depressing and terribly long.”
While most bereaved persons are not actively suicidal, they have no stake in continuing to live. Like Broyard (2005), who
had to go through cancer surgery in the second year after Anatole’s death; and O’Hara (2006), who had to accept and
take responsibility for her anemia which developed following the loss of her son, there needs to be a time for an active
decision to live and take care of one’s physical self…to invest in the process of recovery.
Four months after Bart’s death Jennifer was able to report that she could look forward to a class reunion which should
take place three years hence. “See, I am getting better…I’m actually wanting to be alive in three years.”
This poem, written by Gail Trenhaile and posted on the elderhope.com website in June 2002 expresses her decision to
keep living:
Of Birds and Loss
The young mama bird lay dead under the bush
We both thought it was too sad for words, to see her lying there.
I was 31, you were 4, when Dad died.
I wanted to be left alone to cover myself in grief, and curl up and die.
Life wouldn’t let me.
Life was you needing me, Mike needing me, Curtis needing me,
My job needing me.
No time to curl up and die,
Thank you God!
You are so impatient with Madison’s needing you all day long,
She is Life needing you, Marty needing you, Me needing you.
No time to curl up and die.
Thank you God!
Now, both you and I need our house and our garden and our birds.
Healing is in our needing both each other and
Marty, and Madison and the garden.
Thank you, God!
We could curl up and die like the mama bird, too sad for words,
But we are needed and we won’t.
Love flies us through life, and healing and needing
Keep our wings up.
Thank you God!
I love you my daughter,
You are part of my heart and my soul!
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The Ambivalence of Recovery
While recovery initially offers an unattainable goal, it later becomes a source of fear…a fear that, “if I feel better it will
lead to a loss of connection with my loved one.”
When Jennifer was told in March (4 months after Bart’s death) that her “tone seemed better these days…more futureoriented, interested and invested,” her reply was, “Yes, I feel like I am stronger emotionally. There have been some days
when I didn’t cry or feel I would never crawl out of the overwhelming abyss. I didn’t even dwell on the fact that Monday
was a Monday this week.” (Monday is the day Bart died.) “I find I can accept my ‘life’ better - I still feel depressed when I
wake up each day, but after a little bit I feel I can handle the day. I try to stay so busy I don’t have to think about the
future except for thinking about certain events I’ve scheduled. Weekends are still the worst and I know I need to plan
them better.”
Promptly following this exchange acknowledging her improved affect, Jennifer reported becoming extremely distraught
over the idea that in being able get on with her life she was denying the importance of Bart in her life. She expressed the
fear of forgetting him, or the possibility that others were forgetting him. This apparent fall back into emotional panic
seemed to continue for at least a week. I would recommend caution in commenting upon improved affect to those who
are still in the early stages of grief. They are caught between worlds, the one that “was,” the one they yearn for, and the
one which they have yet to develop.
Broyard (2006) exults, “I am grieving. I am confused. I am disorganized. But I stand up with a clear regard for myself. It’s
not so bad.” This statement of perceiving herself as moving forward is followed by her observations a short while later
that, “I’m letting the debris pile up in the house again. Last night I saw clearly how this messiness keeps me attached to
Anatole. The quality of stuckness and inertia and spending days not accomplishing anything keeps me close and still in
the empty sad, terrifying place of husband, lover, friend gone” (p. 68). That earlier glimpse at her recovering self sends
Broyard back into grieving behaviors to avoid the ultimate loss of Anatole.
Didion (2005) reflects, “I did not want to finish the year because I know that as the days pass, as January becomes
February and February becomes summer, certain things will happen. My image of John at the instant of his death will
become less immediate, less raw. It will become something that happened in another year. My sense of John himself,
John alive, will become more remote, even ‘mudgy,’ softened, transmuted into whatever best serves my life without
him. In fact, this is already beginning to happen. …I know why we try to keep the dead alive: we try to keep them alive in
order to keep them with us” (p. 225).
The ambivalence is expressed as Didion observes, “I also know that if we are to live ourselves there comes a point at
which we must relinquish the dead, let them go, keep them dead. Let them become the photograph on the table. Let
them become the name on the trust accounts. Let go of them in the water. Knowing this does not make it any easier to
let go of him in the water” (p. 225-226).
It is hard for survivors to allow themselves to feel better while believing that it means they’re losing their connection to
the deceased.
Solace for the Bereaved
The internet is a good resource for information and there are many sites which offer free, useful information. I found the
following at http://www.beliefnet.com/Love-Family/2009/09/Offer-Comfort.aspx?p=11. (Retrieved March 1, 2010) The
article was entitled, “Look to the Future – 10 ways to Offer Solace.”
1. Stay in contact with the bereaved. Talk with the bereaved friend or relative even if it is difficult. Remember,
they are in far more pain and discomfort than you. Be present for the first few days. Later call or e-mail regularly
to say you are thinking of them and would like to be useful.
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2. Offer to drive. The bereaved will have many immediate chores to do at a bank, a funeral home or attorney’s
office. They may need help in doing these tasks – if not just be their chauffeur.
3. Bring comfort food. After a week or two most family members will have resumed their usual schedules and are
no longer available to cater to the bereaved. If a person says they don’t want anything bring over soup and ice
cream. These items are good for a person in mourning – they contain enough calories to maintain nutrition yet
require no biting or chewing. Sometimes it is difficult to chew and swallow when in deep mourning.
4. Help out with paperwork. Many forms need to be filled out after a death and the bereaved may not have the
patience. You can ease the job by doing it with the person at your side responding to questions. You could help
address envelopes for thank-you-for-condolences notes.
5. Be a good listener. Most survivors, after a few weeks, need to talk about the death of a loved one. It helps them
process the traumatic event and absorb the reality. If it feels right, ask about the day of death. All you need to
do is listen.
6. Post an internet memorial. Help your grieving friend or relative create an ongoing memorial for their loved one
on the internet. Putting feelings into words and pictures can be healing. Friends and family can post their
prayers as well. There are a number of memorial sites – some free – some charge an annual fee. Beliefnet.com
will post a free memorial for members.
7. Create a keepsake. Encourage the bereaved to create something tangible, something they can look at or carry
around, that reminds them of their loved one. Suggest they make some personal jewelry from the deceased's
jewelry, or perhaps help them create a collage of photos. Choose some photos to fit into their wallet.
8. Consider a pet. After some time has passed, see if the bereaved person would consider getting a pet. Offer to go
along to buy or adopt one. If the person is now alone in the house, for instance, a dog could provide love and
companionship--and a reason to get up and out in the morning.
9. Help them reach out. Assist them in finding a bereavement group; help them expand their social network; find
course offerings at a college, library, house of worship. If necessary, go with them to the first class.
10. Look to the future. After many months, the bereaved will need help in planning for the future. Bring over
information about possible trips, vacations, cruises and special events. Having something to look forward to
prevents constantly look back.
Chapter 4: Grief Dreams
The enormity of the loss of a loved one with the idea of the survivor’s never again seeing this person appears to be
relieved somewhat by grief dreams. Patricia Garfield (1997) writes, “Are these dream images of the dead simply
memories of them infused by our imagination, to help us cope with the grief during bereavement? Are they part of an
internal process we employ to adjust to loss and assist us in solving daily problems? Or are dream images of the dead
actual encounters with the spirit of the deceased? …There is no way yet known to prove either position: that dreams
about the dead are ‘real’ contacts, or that they are images conjured by the dreamer to meet psychological needs” (p. 1920).
Wray and Price (2005) provide some background on dream theory offered by both Freud and Jung. Freud believed that
dreams are the “royal road” to the unconscious, and saw dreams as wish fulfillments. He believed that dreams had both
manifest and latent content. Through the process of psychoanalysis the latent content of the dream could be revealed,
which Freud tended to see within a sexual context.
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In Freud’s view, the purpose of dreams was to allow us to continue to sleep undisturbed. Displacement, he believed was
the process that allowed the psyche to protect itself from emotional upset. “…for example, you are angry with your
mother for dying and leaving you to care for your father who suffers from Alzheimer’s disease. Freud would say that
your anger at your mother would be hidden in the subtext of the dream. Your strong emotions would be displaced as a
way of protecting you from the strong emotions of a more literal dream of, say, shouting at your mother for abandoning
you and your father. You might instead dream of your frustration with your dog’s slipping out the front door. In this
case, your strong feeling of anger at your mother is displaced (with a less intense feeling of frustration) onto your
escaping dog as a gentler replacement for your departed mother” (2005, p. 33).
In interpreting dreams, Freud used the concept of symbolism, typically, the replacement of a sexual object with one
which has no sexual connotation. And he also noted that our dreams can be projections of our own desires onto others;
e.g., “…a woman might dream about her best friend leaving town, when, in reality, it is the dreamer who is consumed
with wanderlust” (2005, p. 34).
Although Wray and Price (2005) give credit and respect to Freud as a pioneer in the field of dream theory and practice,
they see the work of Carl G. Jung as more helpful than that of his mentor, Freud. Jung was more interested in the impact
of the dream on the life of a dreamer than determining the cause of the dream. “Jung felt that dreams pointed beyond
wish fulfillments; indeed, he held the practical view that dreams could help us deal with our current problems” (p. 34).
Jung emphasized that the meaning of dreams will always contribute to our lifelong development. “This prospective or
forward-seeking understanding of dreams in relation to adult development is a central guiding principle of Jungian
theory and practice” (p. 35).
Despite the lack of clarity about the source of grief dreams, Garfield (1997) maintains that these dreams whether
unsettling or reassuring are helpful in assisting grievers get though the necessary grieving process.
The Compassionate Friends is a support group for parents whose children have died.
Zaslow (2006), a newspaper reporter, wrote after attending their annual conference
that the session on “After-Death Communication” was especially well attended. He
further stated that humans have been chronicling visitation dreams since the days of
prehistoric cave paintings. Even though many cultures embrace this concept, Americans
have tended to be more inhibited. However, Zaslow points out that many of the
parents who attended the conference were happy to discuss their dreams. The woman
who led the session on After-Death Communication, and who had lost her 5-year-old
son in 1991, told the attendees that the dream about a late loved one is often a gift.
She cautioned, “Don’t overanalyze it. Accept it with gratitude.”
Whatever the source of the dream visit from the lost loved one, the visit seems to bring solace. In my first dream of my
mother following her suicide, I found myself in a close embrace with her, saying to her, “You’re going to leave me soon,
aren’t you?” I was pleading with her, over and over, “Please don’t.” I woke up sobbing loudly, tears running down my
face, but somehow feeling better for having had her embrace. It was as though I had a chance to say “goodbye.”
Based on the many examinations she has conducted on grief dreams, Garfield (1997) has discerned that these dreams
have a pattern. They, typically, contain several of these nine elements:
1) The Announcement - by “…various signs and sensations, an announcement is made that the border between the
living and the dead is about to be temporarily suspended. In a way, these dream images parallel what mythologist
Joseph Campbell has labeled ‘the call to adventure.’ You – the hero or heroine of your dream – are about to have an
adventure” (page 24-25).
2) The Arrival at the Meeting Place - the meeting place can be anywhere, inside or outside. Often there is some barrier
between the living and the dead such as a gate.
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3) The Dream Messenger - the dream messenger is the deceased, but does the deceased look like he did when you last
saw him? Usually the deceased looks much worse or much better. As distressing as it may be to see the deceased
looking somehow distorted or disfigured, Garfield claims this is quite common, and these images help express “your
feelings of distress about the death. Later on, you are likely to see the person who has died in a much improved
condition” (p. 25-26). If the deceased has died in their latter years, they frequently appear as much younger and
healthier than when death actually occurred. If the deceased was young, or immature, they are frequently seen as
older…existing happily beyond the age of death. These views of the deceased offer both comfort and solace to the
grieving survivors.
4) The Attendants of the Dream Messenger - “Most of your dreams about the dead will contain the deceased and
yourself. However, some dreamers see the dead accompanied by deceased family members or other deceased
people known to the dreamer. Only a very few dreamers reported images of strangers in their dreams… When you
meet your dream messenger, with or without attendants, the threshold between the living and the dead has been
crossed” (p. 30).
5) The Dream Message Delivered - The form of the message delivery within the dream can be through a variety of
means including electronic/technical or in person. The content of the messages can be diverse, anything from “I’m
Suffering,” a dream that occurs early in the grieving process; “I’m Not Really Dead,” also more characteristic of early
grieving while the dreamer is still struggling to accept the reality of the death; “I’m O.K.,” which is a reassuring
message to the dreamer; “Goodbye,” which is a classic dream experienced when one has been deprived of the
opportunity to say “goodbye” to the deceased; or even something more neutral, such as “Hi, How Are You?” which
tends to occur when the grief work has been completed. These theme topics occur throughout the grieving process
as the dreamer is working through the pain of loss (pages 30-37).
6) The Gift of the Dream Messenger - one may receive a specific gift from the deceased. These gifts are usually
interpreted as love by the dreamer.
7) The Farewell Embrace - whether or not the dreamer and the deceased actually touch appears to depend on the
belief system of the dreamer. Some dreamers may fear to touch the deceased because of the deceased’s fragile
state of being; but those who do experience one last hug, “remembered it with joy for years afterward” (p. 38.).
8) The Departure of the Dream Messenger – “Whether the dream messenger departs or the dreamer awakens, the
border between life and death is erected again” (p. 39).
9) The Aftermath of the Visit - For the most part Garfield reports that people respond positively to the visit of the
dream messenger. She adds, “You may not only find yourself solaced by your dream about the dead, but also feel
deeply loved” (p. 40).
Wray and Price (2005) discuss four ways in which dreams help with the grief work:
1) Grief Dreams Absorb Shock – “In the early days of grief, dreams provide a way for survivors to absorb the shock of
death. Often the scene and the circumstances of the death are repeated and reviewed in dream form to help
grievers digest the reality of the death. While awake, mourners are numb, disoriented, stunned, repeating the
words, ‘I just can’t believe it.’ But at night, while sleeping, their dreams are offering doses of the reality of the death
that allow for gradual digestion” (2005, p. 39-40).
2) Grief Dreams Sort Out Our Emotions – “A second shared feature of grief dreaming involves the emotions of the
survivor. Intense feelings about the deceased are exposed in survivors’ dreams. The emotions may include pleasure,
passion, regret, delight, disappointment, joy, guilt, remorse, loneliness, admiration, anger, indifference, relief,
anguish, and always, upon awakening the hollowing sink of loss” (2005, p. 41-42).
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The grief dream offers images that prove helpful in sorting out intense feelings about the deceased; e.g., the burden
of an elderly parent might be represented by the carrying of a heavy backpack. These symbols can provide new ways
to handle the complicated grief emotions of the grief survivor.
3) Grief Dreams Continue Our Inner Relationship with the Deceased – Grief dreams help the dreamer “forge an
internalized relationship with the deceased” (2005, p. 43). Survivors may feel they have found their lost loves, and
tend to welcome their dreams. In situations where the relationship has been troubled or difficult, “…dreams can
help the survivor resolve problems. Dreams can be a window for a better understanding of the deceased and may
provide a way for explanations and apologies. Often survivors report that their dreams eased their guilt and soothed
a more troubled previous relationship” (2005, p. 43).
4) Grief Dreams Make a Creative Bridge to Our Future – As survivors pass beyond the early stages of overwhelming
grief, they may begin to have dreams that provide insight and new meaning. Grief dreams can become “bridges that
hold the relationship with the deceased while reaching into new life for the survivor” (2005, p. 45). These dreams
are, typically, happening as the survivors are reaching what these authors call the “denouement” phase of grief; i.e.,
the rebuilding stage of grief. The survivor may see the deceased as healthy again, or may find some meaning in the
loved one’s death by creating a memorial to the deceased. Some of the churning, unpleasant energy expended
during grieving can be re-focused into meaningful action for the survivor’s future.
There are many unanswered questions about the source of grief dreams. However, there appears to be general
agreement among those who study grief survivors and their dreams that the grief dreams assist survivors in the process
of healing and returning to more functional, meaning-filled lives.
Chapter 5: Bereavement Study
“Spousal Bereavement in Older Adults: Common, Resilient, and Chronic Grief with Defining Characteristics” (2007), a
longitudinal study of 141 bereaved spouses, seeks to “…identify empirically patterns of change in bereavement and to
determine if these clustered patterns of change differ in important demographic, experiential, and clinical variables” (p.
332). The authors hoped that in identifying these patterns they could determine those bereaved spouses who would
most benefit from prevention services or clinical intervention. Definitions of grieving responses include these three: 1)
common grief, normal life functioning is interrupted and depressive symptoms and distress occur for several months
and then return to baseline over months to several years. 2) In contrast, resilient grief refers to the ability of the survivor
to maintain relatively stable, healthy levels of psychological and physical functioning. 3) Chronic grief response has “…
been shown to form a cluster separate from those of disorders found in the DSM-IV, namely major depressive disorder,
generalized anxiety disorder, and posttraumatic stress disorder” (page 333). Persons who match the features of chronic
grief experience “clinically significant impairment in physical and mental health as well as impairments in social, family,
and occupational domains.”
Eligibility for the study included three criteria: 1) death of a spouse, 2) at least 60 years of age, 3) and measurement data
at three points during bereavement. From an original sample of 256 responders, these criteria yielded a sample of 141
participants who were primarily female (68.8%), Caucasian (95.7%), age range 60 – 91 years, currently living alone
(76.6%) and who had been married once (89.4%). The participants had an average educational level of 13.7 years and
had been married for an average of 44.01 years.
Findings from the study reveal that 49% of the sample experienced what would be defined as common grief, 34%
experienced resilient grief, and 17% experienced chronic grief. The 17% (one out of six participants) who experienced
chronic grief were found to suffer the “highest levels of grief and depression, more sudden deaths, the lowest selfesteem, and the highest marital dependency” (p. 332). A significant number of persons in the chronic grief cluster met
the criteria for a diagnosis of complicated grief which is under consideration by the American Psychiatric Association for
the next version of the Diagnostic Statistical Manual.
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The resilient cluster of the sample “maintained below average levels of grief and depression, and higher mental health
levels at all three waves of data collections” (p. 338). Although the resilient cluster perceived themselves as more
“prepared for the death and that the death was more peaceful” (p. 338), they, too, experienced the grief symptoms of
yearning/longing, emptiness, and numbness, particularly in the first wave of data collection which took place an average
of 4.36 months after the event. The resilient group also had the highest scores on self-esteem and on social support, i.e.,
having someone to talk to about one’s concerns. The authors, taking from Stroebe and Stroebe, (1987) speculate that
“self-esteem and high internal control beliefs buffered these resilient bereaved people against the impact of a
particularly stressful type of loss” (p. 338). There are, apparently, mixed results from later research of social support as a
buffer to the effects of stressful life events. Strobe et al (2005) have pointed out that “social support might not uniquely
help bereaved individuals.”
The authors of this bereavement study express their concern for the individuals in the chronic grief cluster. They are
hopeful these individuals can be identified early in the bereavement process so they can be referred for mental health
intervention. There would also appear to be additional benefit in identifying the factors which are involved in the
resilient grief response; i.e., using these factors to help prepare individuals for an almost unavoidable life event,
experiencing grief at the loss of an important relationship. As you read about the concept of resilience in a following
chapter, you will note those who are considered resilient manage to handle any large life stressor without being totally
flattened…they continue to generate strategies for survival.
Chapter 6: Gender Differences in Grieving
The issue of differences in the way that men and women are perceived to grieve and
the outcomes for both male and female grievers needs to be addressed. As you will
note, the literature is heavily weighted in favor of female reporting. The research
literature concurs that more grief research has been conducted by assessments and
interviews with women than with men. In fact, the bereavement study (Ott et al. 2007)
quoted in the preceding chapter reports the same difficulty; i.e., “participants were
primarily female (68.8%).” Since many of you who will be reading this coursework will
have encountered this discrepancy in your own area of expertise, I encourage you to
share your stories, experiences and findings with this author at [email protected].
Thomas Golden, LCSW (1995) reveals that as the sole male grief therapist in a grief
therapy setting in the 1970’s, he was frequently assigned the male clients coming into the clinic. He found that the males
did not seem to “fit” into the treatment program. Over time he realized that since the vast majority of clients who came
in for therapy were, in fact female, the treatment programs had been designed for these female clients. Golden sought
to design a frame of reference that was more suitable for grieving males, and has developed writing, teaching and
speaking opportunities on the topic of men and grief.
Golden believes that men and women require different definitions of grief and strategies for dealing with grief. For men,
he has replaced definitions that use “feeling” terms with the terms “chaos and desire.” He also observes that men and
women use different strategies to solve the difficult problem of grief. When a woman feels lost or overwhelmed, she
asks for help; when a man needing help feels lost or overwhelmed, he looks for maps. Golden has written three booklets
that he hopes will be the maps for men facing the difficult problem of loss and grief.
Martin and Doka (1999) suggest that we need to look beyond gender to explain the differences in the way one grieves.
They propose three basic patterns of grief:
1. Intuitive Pattern - Grievers experience, express and adapt to their grief on a very affective level. They tend to
report their emotions as waves of affect or feeling. Self-help and support groups that provide opportunities for
these grievers to ventilate feelings are likely to be helpful.
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2. Instrumental Pattern – Those who are Instrumental grievers tend to experience, express, and adapt to grief in
more active and cognitive ways. Instrumental grievers will tend to experience grief as thoughts, such as a
flooding of memories or in physical or behavioral manifestations. Doing something related to the loss, exercising
or talking about the loss are potentially ways in which they are likely to express their grief. In one case, a father
whose daughter had died in an automobile accident found solace in repairing the fence his daughter had
wrecked. “It was,” he shared later, “the only part of the accident I could fix.”
3. Dissonant Pattern – Those who experience grief in one pattern but feel constrained from finding an appropriate
way to express or adapt to their grief, are described as experiencing a dissonant pattern. For example, a man
who experiences his grief intuitively may feel constrained from expressing or adapting to grief in this way
because it is contrary to his male role. On the other hand, a woman who experiences grief in an intuitive way
may feel that she cannot express her feeling in order to protect other members of her family.
The value of rituals for all three types of grievers is underlined by Martin and Doka as the rituals provide a container to
hold the grief. Through meaningful rituals, intuitive grievers have an opportunity for affective ventilation, and
instrumental or dissonant grievers may limit their exposure to grief.
Martin and Doka also suggest that in Western Culture, many men are likely to be found on the instrumental end of the
continuum, whereas women are more likely to be found on the intuitive end. Using Myers Briggs terminology, this
would fall into the differences between those who have a decision-making preference for Thinking (a problem-solving
orientation) versus those who have a decision-making preference for Feeling (those who attend to the impact on
people). Chapter 9 of this course, “Repairing/Rebuilding the Self,” will provide expanded descriptions of the MyersBriggs preference types.
W. Strobe, et al (1999), report an interesting feature of their study, “The Dual Process Model of Coping with
Bereavement: Rationale and Description.” In developing their sample of bereaved to participate in the study, they were
able to collect a subgroup of bereaved that were unwilling to participate in interviews exploring their loss experience,
but indicated their willingness to participate in a postal questionnaire.
Including these interview “refusers” as one of their sub-groups, the researchers discovered a significant interaction
between sex and willingness to participate. “It was the less depressed widowers but the more depressed widows who
were willing to undergo the bereavement interviews” (p. 4). This finding goes a long way toward explaining why we
obtain more bereavement data from females than from males. Apparently, widowers who are suffering the most are
unwilling to expose themselves to an interview situation, whereas widows who are suffering are willing to encounter
this verbal and potentially emotion-laden, situation.
The measures of loneliness administered to the bereaved and their matched control group of “marrieds” reported
greater loneliness and more depressive symptomatology for the bereaved, “and this effect of bereavement seems to be
stronger for widowers than widows” (p. 9). Interestingly, only among the interview “refusers” was this sex difference of
greater depressive symptomatology and loneliness apparent. “For the interview accepters there was no evidence of a
sex difference in bereavement outcome” (p. 9).
W. Strobe et al. continue in their analysis to explain that the pattern encountered in this study reflects sex differences in
norms of acceptable behavior for men versus women. When faced with a devastating event, men are expected to
control their emotions; women are allowed or expected to express their feelings. Therefore, for a man to break down
and cry during an interview is much more embarrassing than the same event is for a woman. The researchers conclude
that those widowers who are most depressed are least likely to agree to participate in an interview situation. Men are,
therefore, generally under-represented in bereavement studies.
Another way to interpret their data, however, is in terms of the Myers Briggs Extraverts and Introverts.
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Introverts (male or female) do not want to be asked to respond verbally to issues that they have not yet had time to
think through. They would generally be unwilling to accept participation in a study where they would be required to
discuss their experience with such an overwhelming stressor as loss of a loved one. A questionnaire received through
the mail would provide them the opportunity to think through their experience before being required to answer.
Extraverts (male or female), who prefer to think aloud, would not feel threatened by the prospect of needing to
verbalize their responses to another human being. We would anticipate that Extraverts would be more prevalent in an
interview situation.
As stated above, the measures of loneliness administered in the W. Strobe et al. (1999) study reported “For the
interview accepters there was no evidence of a sex difference in bereavement outcome.” Potentially this was largely a
group of Extraverts who, even under the stress of bereavement, find it easier to stay connected to the outside world of
human relationships. This connectedness may reduce the tendency to fall into depression. Whereas Introverts
confronted with such a major loss and the need to be able to think it through, may resist human connections potentially
leading to an isolated, depressive environment.
An abstract of a bereavement study examining gender differences conducted by Lund et al. (1984) provides a view of
what happens when the study avoids tapping into the variable of Introversion-Extraversion. Lund et al. conducted a twoyear longitudinal study of bereaved persons between the ages of 50 and 93 years of age. Interview questionnaires were
sent out at six time intervals over a period of two years following the spouse’s death. No statistically significant
differences were found between men and women responders at any of the six time intervals, indicating that the
bereavement processes of men and women were characterized more by similarities than differences.
With this study requiring only mailed-in questionnaires rather than interview sessions, sex differences seemed to
disappear. The problem of getting an accurate picture of bereavement for both men and women requires access to both
in ways that do not create “refusers.”
There are findings of sex role differences in what seems to work therapeutically for grieving men and women. Women
appear better able to work with feeling-oriented strategies; males appear to work better with cognitive and behavioral
strategies. However, we cannot say this is 100% true for all males and for all females. We must continue to work with
what the individual brings to us, and it may very well defy generalized statements.
The Myers Briggs literature shows us that there are at least sixteen different and distinct personal styles of operation.
This being true, the ability to make statements that apply to all men or to all women is not going to be possible. Maybe it
is enough to be aware of trends, but one also needs to develop an awareness of exceptions to those trends.
Data from many of these bereavement studies is suggestive of Introvert/Extravert differences affecting participation in
the studies. In order to get useful information relating to grieving individuals we will be required to make sure our
studies include both Introverts and Extraverts. Many of the available studies appear to have screened in Extraverts and
screened out Introverts.
Chapter 7: Issue of Resilience
With the Ott et al. (2007) bereavement study indicating that those in the resilient group do much better than the other
grief survivors, we need to examine what this means in terms of grief recovery for the average person. Disasters such as
Hurricane Katrina and 9/11 have focused research attention on the concept of resilience. Beth Howard’s (2009) article
from AARP The Magazine sheds some light on the work that has been done to explore the topic. She reports that Brooks
and Goldstein (2004) co-authors of the book, The Power of Resilience, believe there is a genetic component to the
resilience behaviors. However, the authors also believe that almost any behavior can be learned.
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Research has shown that resilient people share some common qualities; qualities which once cultivated can help to
master any crisis:
1)
2)
3)
4)
5)
6)
7)
8)
they stay connected and are willing to ask for help in tough times;
they are optimistic, tending to reframe difficult situations in a more positive light;
they’re spiritual;
they’re playful, they can laugh;
they give to others;
they pick their battles, choosing not to waste their time focused on issues over which they have no control;
they take care of themselves, eating a healthy diet and getting regular physical exercise; and
they find the silver lining, they see negative events as an opportunity to overcome adversity and become better
people.
Mayo Clinic has also posted an article on their website entitled “Resilience: Build Skills to Endure Hardship.” The thrust
of this article is that resilient people “roll with the punches.” They keep functioning both physically and psychologically
in the face of adversity, trauma, stress or tragedy. This article also lists a number of tips to strengthen resilience, once
again suggesting that these behaviors can be learned.
Brooks and Goldstein (2004) bring us additional information on this topic in their discussion of a resilient mindset, which
they describe as a set of assumptions and attitudes individuals have about themselves that influence their behaviors and
the skills they develop. The authors do not suggest that a resilient mindset protects one from stress, pressure or conflict,
but that the resilient mindset helps those who possess it to cope with problems as they appear. They believe that a
resilient mindset is composed of the following features (p 3):
•
•
•
•
•
•
•
•
•
•
Feeling in control of one’s life
Knowing how to fortify one’s “stress hardiness”
Being empathic
Displaying effective communication and other interpersonal capabilities
Possessing solid problem-solving and decision-making skills
Establishing realistic goals and expectations
Learning from both success and failure
Being a compassionate and contributing member of society
Living a responsible life based on a set of thoughtful values
Feeling special (not self-centered) while helping others to feel the same
It is not that persons seen as resilient don’t suffer…they certainly do. However, they
begin working to right their ship before it sinks. Although none of us can control the
winds that blow us about, we can adjust our sails to meet the challenge the wind
presents.
According to Brooks and Goldstein (2004), the chief culprit that stands in the way of
attaining a resilient mindset is the negative script which we continue to replay even in
the face of unacceptable results. If, for example, our approach to our family or to our
co-workers is not bringing the results we hoped for, it is time to examine the assumptions and behaviors that are not
working. This examination may require the help of a therapist, but the benefit could be that we change these negative
scripts to positive ones that do bring us hoped-for-results.
Another deadly dynamic is the belief that our problems are the result of the behavior of someone else. The authors
encourage us to take responsibility for our own behaviors and not to expect others to do the changing. The question to
ask is, “What is it that I can do differently to change the situation?” (p. 7).
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It is doubtful that those persons labeled chronic grievers could take on the challenge of self-development that learning
resilience behaviors would require. However, with the assistance of a therapist, they might be able to learn to assess
their own situation differently, identify and dissect some of their negative scripts, work to adjust their own behaviors in
order to achieve better outcomes, learn to ask for help, learn to physically care for themselves, and begin to identify
some activities that would provide an outlet from the omnipresent grief. The survivors whose experience meets the
definition of common grief might be able to confront the learning of resilience behaviors as a part of a therapy group.
Well-led grief groups are reported as being very helpful and supportive for those experiencing the loss of loved ones.
Those preferring a more instrumental pattern of grieving might find this cognitive approach to grieving more palatable
than just an open forum for discussing feelings.
With the recent interest in resilience and new books on the topic becoming available, I would suspect that the general
public will also take an interest in the concept. Some of these readers may take on the challenge of developing or
strengthening their resilience behaviors. Consciousness allows people to make positive decisions to change.
Tagliaferre and Harbaugh (2001) report on their use of the Coping Resources Inventory (CRI) developed by Allen
Hammer and M. Susan Marting. The CRI helps to assess the effectiveness of individuals’ coping strategies along five
dimensions: Cognitive, Social, Emotional, Spiritual, and Physical. These five dimensions can then be linked with the
sixteen types represented on the Myers Briggs Type Indicator (MBTI) to suggest how effectively each of the 16 types will
manage stress. Using a sample size of 112 persons who took the MBTI and the CRI, Tagliaferre and Harbaugh (2001)
ranked the sample according to the coping resources available to each of the 16 types. The following types are ranked
according to those reporting the most coping resources down to those who report the least: ENFP; INFJ; ESFP; ISFJ;
ENTP; ESTJ; ISTP; ESFJ; ENFJ; ISFP; INFP; INTJ; ISTJ; INTP. (There were no ESTP types in the sample.)
It would be very interesting to compare the rankings of perceived coping strategies of the different psychological types
to the MBTI types of persons who fall into the three different groupings (common grief, resilient grief or chronic grief)
referred to in the Bereavement Study (Ott, et. al. 2007). There is certainly room for additional research along these lines.
In their efforts to delineate strategies that help one recover from loss, Tagliaferre and Harbaugh (2001) indicate “Clinical
experience using the Coping Resources Inventory has suggested that the intervention aimed at helping individuals deal
with stress should be directed toward helping them identify and bring into use the full range of resources available to
them.” The authors further suggest, “Special attention may need to be directed toward identifying Introverts who may
not be coping well and in helping them develop more effective coping strategies and resources. This support may be
especially needed by those who ranked low on the total CRI scores (for example, ISTJ and INTP)” (2001, p. 53). Although
Taglieffere and Harbaugh do not elaborate beyond this statement, as a therapist who is an Extravert, and one who has
used the MBTI in my practice, my concern for Introverts is that they can, without some thoughtful effort, be at risk of
becoming isolated when death takes their partner. With their preference for a smaller group of social connections,
losing the partner or spouse can leave a very large hole in their connectedness to others. A more lengthy discussion of
the MBTI will be found in Chapter 9.
Chapter 8: Medical Problems of the Bereaved
A UK study authored by Charlton, R. et.al. (2001) cautions us that, “Bereavement can be viewed as a medical problem,
but this is not borne out in prescribing and so care should be taken not to over-medicalize grief.” His study utilized a
group of 122 bereaved spouses from a West Midlands general practice. A sample of 100 individuals were selected from
that group to have their medical records analyzed for a significant change between the patients’ pre-bereaved (12
months) and post-bereaved (12 months) office consultations and medication requirements. The relationship between
each patient and the number of prescriptions written for that patient post-bereavement increased, but not significantly.
The number of office consultations increased, but for physical rather than psychological illnesses. Therefore, while the
authors did not see an increase in what they would term psychological problems, they did see an increase in the
reporting of physical problems.
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We also have the study of Ott et.al. (2007) indicating 17% of the post-bereaved survivors fell into the chronic grief
category requiring additional physical and/or psychological support. Tagliaferre and Harbaugh (2001) report that “there
are more than 2.4 million deaths in this country annually (about four each minute)…” (p. 12). If we use the 17% figure
reported by Ott et.al. (2007) to determine the number of those who might be expected to suffer chronic grief, we are
looking at a large number; as many as 408,000 persons each year may require extra physical and/or psychological
intervention.
The DSM-IV-TR (2000), the latest version of the manual of mental disorders available, has listed “Bereavement” under
the V Codes (V62.82). The narrative description is as follows:
“This category can be used when the focus of clinical attention is a reaction to the death of a loved one. As part of their
reaction to the loss, some grieving individuals present with symptoms characteristic of a Major Depressive Episode (e.g.,
feelings of sadness and associated symptoms such as insomnia, poor appetite, and weight loss). The bereaved individual
typically regards the depressed mood as ‘normal,’ although the person may seek professional help for relief of
associated symptoms such as insomnia or anorexia. The duration and expression of ‘normal’ bereavement vary
considerably among different cultural groups. The diagnosis of Major Depressive Disorder is generally not given unless
the symptoms are still present 2 months after the loss. However, the presence of certain symptoms that are not
characteristic of a ‘normal’ grief reaction may be helpful in differentiating bereavement from a Major Depressive
Episode. These include 1) guilt about things other than actions taken or not taken by the survivor at the time of the
death; 2) thoughts of death other than the survivor feeling that he or she would be better off dead or should have died
with the deceased person; 3) morbid preoccupation with worthlessness; 4) marked psychomotor retardation; 5)
prolonged and marked functional impairment; and 6) hallucinatory experiences other than thinking that he or she hears
the voice of, or transiently sees the image of, the deceased person,” (p. 740-741).
In their review of the literature, Strobe et al (2005) posit that the bereaved persons who can derive benefit from
counseling and therapy are those who have been unable to cope with the loss and for whom the grief process has
deviated from the norm. Complicated grief is the term that has been used to describe those who are suffering from
maladjustment and psychiatric problems.
These authors’ recommendation to forego counseling and psychotherapy for those bereaved individuals who do not fall
into the category of complicated grief is the result of having reviewed many studies on the effects of social support and
emotional disclosure for bereaved individuals. Many of these individuals were recruited to participate in bereavement
studies. The interventions available were 1) primary interventions, i.e., they were open to all bereaved; 2) secondary
preventive interventions available to those individuals who through a screening for risk factors were thought to be
vulnerable; and 3) tertiary preventive interventions which were directed at those who suffered from complicated grief.
Strobe et al (2005) conclude, “Tertiary interventions which focused on bereaved
individuals who had already developed complicated grief reaction were most
effective” (p. 408). They continue, “Although the support of family and friends is
positively associated with well-being among the bereaved, there is little
evidence that social support moderates the impact of bereavement on
psychological health and/or accelerates adjustment to the loss and this despite
the fact that distress levels are rather high among the recently bereaved. Since
we had assumed that the facilitation of emotional disclosure was one of the
ways through which social support would facilitate coping with loss, the failure to find evidence that disclosure of
emotions (whether natural or induced) facilitates adjustment to loss goes some way toward explaining why social
support failed to enhance recovery from bereavement.”
Emotional loneliness through the loss of a close personal attachment is felt by the authors to be the most common
difficulty suffered by those who experience un-complicated grief. Further, they posit, “It is possible that this type of
loneliness only abates with time and that nothing can be done to further the recovery process” (p. 409).
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Strobe et al (2005) are unable to demonstrate the usefulness of counseling and psychotherapy (which offers both
support and the opportunity for emotional disclosure) for any of the bereaved with the exception of those they refer to
as suffering from complicated grief. These are the same individuals that Ott et al. (2007) defined as chronic grievers and
for whom they expressed real concern. Strobe et al (2005) make a good case for questioning the usefulness of
traditional counseling for those who are not at risk for or suffering from complicated grief. They do not attempt to
address the impact of uncomplicated grief on physical health.
There are unanswered questions as to whether or not bereavement is a medical problem for most bereaved persons.
We must consider the fact that one of life’s largest stressors is the death of a loved one. Many studies have indicated
that high levels of stress impact our physical functioning and well-being. Tagliaferre and Harbaugh (2001) report on a
1984 government study of grief prepared by the Institute of Medicine of the National Academy of Science entitled
“Bereavement, Reactions, Consequences, and Care.” Mourners were found to suffer far longer than anticipated with
“symptoms that include depression, lowered immune system defenses and disorientation, resulting in loss of
employment productivity” (p. 12). Tagliaferre reports that he himself suffered with suicidal thoughts in the early stages
of grief after his wife died.
The stress overload caused by the death of a loved one can increase one’s own susceptibility to physical illness through
decreased immune response or decreased self-care such as O’Hara (2006) describes. She reports the variety of physical
symptoms she experienced following Aaron’s death. She was “exhausted and felt weak most of the time” (p. 77-78). She
had aches and pains she’d never experienced before; during intense grief responses she would feel as though she were
having a heart attack. Her physician was able to reassure her about most of her symptoms, but did discover that O’Hara
was anemic. Initially, because she did not take this problem seriously, it became worse. She was, ultimately able to make
herself face the problem and begin to eat better. She realized by not taking care of herself she would make her journey
of grief even more difficult.
Short-term stress responses are designed for just that and are described as flight or fight responses. However, the grief
response is not short-term. The continued over-production of steroids increases both heart rate and blood pressure and
can lead to exacerbation of pre-existing health problems or the appearance of new problems. After my mother’s suicide
my blood-pressure problem, which had been well-controlled for some time, became an out-of-control problem requiring
continued attention for a number of months.
Those who have lost a loved one to a particular physical illness frequently begin to assess the symptoms of that illness
within themselves. Under ideal circumstances, those who are fearful of finding their partner’s illness within themselves
will see a physician and get that question resolved. After Bart’s death, Jennifer experienced physical symptoms that led
her to her doctor’s office. Her doctor gave her a physical exam and then referred her for a colonoscopy; happily, he was
able to inform her that she did not have colon cancer.
When the partner’s illness does show up in the grieving survivor it can be quite frightening. Broyard (2005), in her
second year after Anatole’s death from prostate cancer, found that she herself had cancer and would need a
hysterectomy. This news caused her anxiety close to panic. The doctor informed Broyard that squamous-type cancer
cells were present in the biopsy tissue. While this indicated the cancer had “not burrowed deep into surrounding tissue,”
the treatment required a surgical intervention to remove the cervix and the uterus. Shortly after surgery, Broyard
became aware of how physically vulnerable she was. With her daughter’s help, she traveled to the Vineyard to recover,
but remained in the house alone. When she experienced some bleeding following a walk on the beach she realized that
she would have to be more cautious. Being so totally alone, no one would be available to help her if she encountered a
physical emergency. For twenty-nine years of her life Broyard had relied on Anatole for support and protection in time
of crisis. That buffer was now gone. She would have to assume the full responsibility for her own physical well-being.
Although the recently bereaved report many medical problems and stress studies indicate the propensity of the highly
stressed to encounter stress-related physical problems, there is no universal agreement as to how big this problem is.
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Chapter 9: Repairing /Rebuilding the Self
As we have noted earlier the impact on the self system is a major disorganizing factor in surviving and recovering from
the loss of a loved one. When the grief survivor begins to enter the second stage of grief, i.e., internalizing the loss as
real, the work of rebuilding the self begins.
Broyard (2005, p. 127) speaks of her “emerging me” when she writes, “the me that is emerging, the me that thrills in
dance classes, the me that writes, the me that helps people.” These are the elements of her new, developing self that
she can value and appreciate. Early in her grief process Broyard chose to reconnect with dancing, a very important part
of her earlier life. As she draws her story to a conclusion, she reports that she has winterized her Vineyard home and
now lives there permanently; she has “…a small psychotherapy practice, volunteers in a community project and
continues dancing and even performing each winter with Vineyard Dance, a group of eighteen or so women” (p. 210).
Broyard has put together her altered self through the use of some new interests along with the interests from her past.
Interests from the past are her dancing, her love for the water, and her desire to help other people. To that, she has
added her new discovery, i.e., her enjoyment of and gift for writing. From Anatole’s notes she was able to complete
some of his work for publication and has written the story of her own grief journey, Standby (2005).
O’Hara (2006, p. 21) who writes of surviving the violent deaths of loved ones suggests the survivor try to recover the
image of the self prior to the violent event. This exercise would be useful for anyone who is the survivor of the death of
a loved one. It is designed to recover the image of self just prior to the death. O’Hara’s suggestion is a writing exercise to
include the following:
•
•
•
•
Date, time
Weather
I was happy, sad, depressed, optimistic…
I liked doing the following things…
•
•
•
•
I worked at…
My family members were…
I worried about…
I had dreams of becoming…
One of the tools that can offer significant help in recrafting the self is the Myers Briggs
Type Indicator (MBTI) (Briggs and McCaulley, 1985). This is a self-assessment developed
by Katherine C. Briggs and Isabel Briggs Myers, a mother/daughter team, who sought to
make understandable and useful, Carl G. Jung’s theory of psychological types.
“The essence of the theory is that much seemingly random variation in behavior is
actually quite orderly and consistent, being due to basic differences in the way
individuals prefer to use their perception and judgment. Perception involves all the ways
of becoming aware of things, people, happenings, or ideas. Judgment involves all the
ways of coming to conclusions about what has been perceived. If people differ
systematically in what they perceive and in how they reach conclusions, then it is only
reasonable for them to differ correspondingly in their reactions, interests, values,
motivations, skills, and interests” (Briggs and McCaulley, 1985, p. 1).
Most people assume that others see things just as they do, and are therefore, mystified at the conclusions someone else
may draw from what are assumed to be the same set of perceptions. Throughout my years as a Marriage and Family
Therapist, the MBTI has been a tool that I have found tremendously helpful in working with couples or families in
distress. The MBTI does not discuss pathology, but delineates normal differences between normal people. Through the
years of my practice and now beyond that, I perceive the tremendous value that the MBTI provides for the
understanding of our own behavior as well as the behavior of others. It is not surprising, therefore, that I would see the
MBTI as a great value in looking at issues of self. The important fact to remember when using the MBTI is that all
preferences are good; our personal preferences represent what we have favored and developed more fully than our
non-preferences; everyone uses their non-preferences…just not as competently or as frequently as their preferences.
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The MBTI provides four scales of opposite preferences (Myers, 1987):
1) Extraversion (E) and Introversion (I) represent opposite preferences for a focus of our attention or energy. Extraverts
prefer the outside world of people, events and activities. They would prefer to be doing rather than thinking about
doing. Extraverts tend to be action-oriented individuals who learn by experiencing and whose focus of attention is
the outer world. Because of all their outward activity, Extraverts generate a large number of people connections.
Introverts, however, tend to focus their attention and their energy inward within their own heads, enjoying reflective
thinking before developing actions for doing. Introverts prefer to think things through before discussing them or
experiencing them. They are liable to feel intruded upon by the extravert’s need to discuss a new project before they
(the introverts) have had time to first think it through. Because of the more inward direction of energy, Introverts tend
to generate a smaller group of people connections, but those they call “friends” are truly persons who are wellconnected to them.
Because of the normal differences between Introverts and Extraverts, Introverts are frequently perceived as
“withholding” and unwilling to participate in brainstorming sessions. Extraverts prefer to “think” out loud and are, at the
drop of a hat, willing to brain-storm. Because of this preference for thinking aloud, Extraverts are frequently perceived
by Introverts as pushy or trying to dominate the conversation in such settings. With information as to the meaning of
these differences, conflict can be avoided and Introverts can be given time to think about the issue before being asked
to do any brain-storming. That way the best of what both preferences have to offer can be utilized.
2) Sensing (S) and Intuition (N) represent opposite preferences for how we like to acquire or perceive information.
Sensing is a way to discover through your eyes, ears and other senses what is happening both inside and outside
yourself. Those who prefer Sensing are particularly good at gathering the here-and-now realities of a situation. Their
preference for sensing allows them to become both realistic and practical, and they are good with details and
working with a large number of facts.
Intuition is the other way for perceiving. It focuses on meanings, relationships and possibilities that go beyond the
information from the senses. Intuition tends to look at the big picture and tries to grasp the essential patterns. Those
who prefer intuition develop an interest in seeing new possibilities and new ways of doing things. They value inspiration
and imagination.
Because of the perfectly normal differences between those preferring Sensing and those preferring Intuition, Sensing
realists frequently perceive Intuitives as idealistic dreamers, and Intuitives feel bogged down with the Sensing need to
gather so many facts before moving on to possibilities. Of course, with understanding they can use these differences to
enhance their opportunities for success in any situation.
3) Thinking (T) and Feeling (F) represent opposite preferences for ways in which we come to judgment or make
decisions. Having gathered information through our perceiving preference (either S or N), we use that information
to reach a conclusion or decision.
Those with a Thinking preference come to an objective decision based on cause and effect. They analyze and weigh the
evidence, both positive and negative to reach a decision. They are frequently good at determining what is wrong within
a situation. Typically, we expect a gender breakdown of about 66% males and about 34% females who have a Thinking
preference.
Those with a Feeling preference come to a decision based on personal and group values. Their decisions are closely
connected with the perceived impact on people. Those with a preference for feeling tend to become sympathetic,
appreciative, and tactful. (“It is important to understand that the word ‘feeling,’ when used here, means making
decisions based on values; it does not refer to your feelings or emotions”) (Briggs and McCaulley, 1985, p. 6). Typically,
we expect a gender breakdown of about 66% females and 34% males who have a preference for Feeling.
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Because the Thinking preference automatically assesses what is wrong in a situation and the Feeling preference
automatically assesses what is to be appreciated in a situation, this difference frequently leads to conflict between the
two. Again, with some understanding of these differences, both those preferring Thinking and those preferring Feeling
can appreciate the value of having both of these bases covered. A good decision is one in which the factual analysis of
the situation, as well as the impact on people, is addressed.
When these differences in personal style between the Thinking preference and the Feeling preference are considered, it
is logical to see that those who are bereaved are required to stretch beyond their preference to also utilize their nonpreference. The bereaved are being required to reconfigure their self as one who addresses problem-solving needs as
well as value-based needs with increased competence. There will be some initial discomfort with this stretch until new
skills are acquired.
4) Judgment (J) and Perception (P) represent two opposite ways in which people orient themselves toward the world.
Those with a Judging preference are ready to make a decision (come to closure) as soon as they believe they have
gathered enough information to do so. Those with a Judging preference prefer things to be structured and organized
and want them to be settled. They are typically good at goal-setting. They are good at meeting deadlines in a
planful, orderly fashion.
Perception (P) is, typically, not certain that enough information is yet available and, therefore, is unwilling to bring things
to closure before experiencing a second look. Those with a perceiving preference like to keep their options open,
enjoying and trusting their ability to adapt to the moment. They tend to develop goals as they begin moving toward the
future. They tend to be spontaneous and adaptable and sometimes overload their time schedules making it tricky to
meet deadlines.
This J and P preference, a perfectly normal difference between people, can create a great deal of strife in the ways these
opposites deal with time and decisions. The downside of the Judging preference is that they sometimes are so eager for
closure they neglect some important information which could alter the direction of the goal. The downside of the
Perceiving preference is that they sometimes put the decision off for so long that they lose the window of opportunity.
Again, with information and understanding, these differences can be accommodated and appreciated for the added
value that comes with having both preferences represented.
After the Indicator has been administered and scored, a
four-letter type is revealed…this represents the preference
on each of the four scales of the MBTI of the person who
has taken the Indicator. There are 16 possible
combinations of the four scales and each of the
combinations yields a narrative that describes how a
person with those four preferences will prefer to operate
in the world. This information is usually confirming to the
person who has taken the Indicator. It is a wonderful
snapshot of our self and serves to help individuals make
connections to choices and behaviors which one knows to
be part of oneself.
For example, Jennifer, who has preferences for INFP,
understands her preferences and can use this information
as a means of developing a map for recovering and
restructuring her self. Her preferences are for Introversion (source of energy inward), Intuition (prefers theories,
patterns and possibilities as her perceiving style), Feeling (when making a decision relies on values and impact on
people) and Perceiving (does not trust quick decision-making, would prefer to continue gathering information prior to
the decision; is spontaneous, adaptable). Her dominant preference is Feeling.
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A capsule description of each of the sixteen psychological types is presented in Gordon Lawrence’s “Descriptions of the
Sixteen Types” (1998). His description of an INFP reads: “Imaginative, independent HELPERS, reflective, inquisitive,
empathic, loyal to ideals: more tuned to possibilities than practicalities. Having introverted FEELING as their strongest
mental process, they are at their best when their inner ideals find expression in their helping of people. They value:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Harmony in the inner life of ideas
Harmonious work settings; working individually
Seeing the big picture possibilities
Creativity; curiosity, exploring
Helping people find their potential
Giving ample time to reflect on decisions
Adaptability and openness
Compassion and caring; attention to feelings
Work that lets them express their idealism
Gentle, respectful interactions
An inner compass; being unique
Showing appreciation and being appreciated
Ideas, language and writing
A close, loyal friend
Perfecting what is important.”
What does Introversion suggest about Jennifer’s style of behavior? While Jennifer is very social; her preference for
Introversion suggests that she has a smaller group of close friends with whom she tends to spend time. It also suggests
that she may not feel comfortable in reaching out to new persons to bring them into her friendship network. Jennifer
and Bart were involved in church work and community activities, giving generously of their time; however, even with a
large number of community connections, these connections were not necessarily part of the small network of close
friends who were important in their ongoing lives. With Bart’s death, Jennifer was left with limited, meaningful, social
connections. In order to connect with persons who might share some of her same needs and interests she is required to
make planful overtures toward others, initiating the contact, which is a psychological stretch for her. Through her
existing social network, Jennifer needs to start identifying other single women, or widows who might be interested in
activities which she, herself enjoys.
One of the additional losses for those who lose a spouse is the loss of the “couple friends” as a social outlet. Although
the couple friends make efforts to include a single member, over time, it does not seem to work well. Jennifer will need
more single friends who are also interested in traveling or attending social events so that she will not have to do all
these activities alone. This means she will have to actively seek new connections. This is difficult behavior for an
Introvert. However, since Jennifer understands this about herself, she makes plans to overcome her natural resistance
and reaches out to new acquaintances who may become part of her new, social network.
Jennifer’s preference for Intuition makes it difficult for her to step into the role that Bart has taken for the thirty-seven
years they enjoyed together. Jennifer is now required to take over the financial accounts, make decisions about
insurance needs, file tax forms and all other government-generated forms. Bart, who was an accountant by profession,
was the natural choice to handle these matters; and Bart’s preference for Sensing was an asset for being in charge of
this detailed work. Jennifer, who has been able to avoid these activities (Intuitives do not enjoy details) is now faced
with the need to understand all these requirements and perform competently in order to manage them. Since these
chores are not represented in her preferences, she is required to do some skill-building in order to manage these tasks.
Although each of us would prefer to do only those things which represent our psychological preferences, life doesn’t
generally provide us those opportunities…we are required to stretch beyond our preferences to build the skills we need
to survive. And so, Jennifer, with the help of some of her family members who do well with Sensing tasks, is working to
develop greater competence in these areas.
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Jennifer will be well served by her preference for Intuition as she searches for new ways to do things, new possibilities.
That is the forte of the Intuiting preference. In fact, Jennifer’s new plan to rent a studio in an art cooperative is, no
doubt, the outgrowth of her Intuition helping to direct her to a new, acceptable way in which she can get back to her
painting. Her love of travel, seeing and experiencing new places will need an outlet. She, reportedly, has a female friend
with whom she is planning to travel to Alaska next summer. Hopefully, she will be making friendship connections which
allow her to continue to have new experiences which are so important to her ongoing enjoyment of life. There is no
expectation that Jennifer will become an Extravert, only that she will fill the hole left by the death of Bart who was her
major social outlet and the entree to her travel experiences.
The dominant F in Jennifer’s preferences shows up vividly in her everyday living. She has a leadership role in many
church activities, which represent an important value to her, but on a person-to-person level, Jennifer’s willingness to be
a companion and chauffeur to friends and acquaintances that need to be taken for medical care is notable. She also
frequently takes a dinner or a food item to those just home from the hospital or who are themselves survivors of grief.
Her helping, caring activities re-emerged early in her own grieving process. This is an essential part of her being, and the
fact that she has responded to it through the trials of her own grief is a real positive for re-gathering pieces of her self.
Revisiting her preference for Perceiving may help her avoid continually “overloading her plate.” She accepts so many
requests for help or for invitations to participate that she sometimes has a difficult time meeting all the commitments
she makes. This can be exhausting for one who would never knowingly let down another person.
Jennifer is on her way in the quest for restructuring her self. But it is a journey still. To
complete all that she is required to do as a single person, plus accomplish all that is
important to her in terms of her art and helping others, and meeting her family and
community obligations is a BIG job. It will take her some time to figure out how to do all
these things as a single individual, and to enjoy them as a single individual. Jennifer’s
continuing experience has provided us a way to look at the usefulness of the MBTI as a
tool for helping a grief survivor recover important elements of the self. However, in
Jennifer’s case the MBTI was already available to her. As an educator, she had
encountered the instrument when she was in graduate school. Increasingly, more
professional fields are using the MBTI either as part of their academic curriculum or in the
organizational development process once entered into the business world. Since the MBTI
is a self-report measure, the results can be impacted by a trauma in one’s life. I would not
recommend administering the MBTI to anyone in the first six months of bereavement. Then, depending upon the
person, I would consider administering it as an aid in the restructuring of the self.
There are other ways of being able to gather some of this information if you determine that your client is not yet ready
to generate responses to the Indicator. Interviewing for information about:
1)
2)
3)
4)
5)
6)
7)
8)
Who were you before this death happened?
How did you spend your time?
What kinds of things did you like to do?
Were these solitary activities or with other people?
What kinds of work did you do?
What elements of the work came easily versus those that were more difficult?
What elements of work were more pleasurable versus those you tended to put off?
What did you do for enjoyment?
These kinds of questions can help define the pre-grief self that becomes a landmark toward which a grief survivor can
begin to approach. As a newly single person who is no longer part of a two-some, the grief survivor will make
modifications in this pre-grief self, adding some items that are now possible to consider, and culling out some that were
more important while operating as a shared identity with a spouse or other loved one. Nevertheless, this is the major
work of grief recovery…regaining a sense of an operational self.
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If you would like to obtain additional information relating to the MBTI, I would recommend three major resources:
Center for Application of Psychological Type (CAPT), the Association for Psychological Type International (APTi), and the
test publisher, Consulting Psychologists Press (CPP). All three are listed in the Resources Section in the Appendix.
There is a large body of literature available describing the MBTI, its use in a number of settings, becoming qualified to
purchase and use the material, studies that are ongoing, and seminars or conferences that take place frequently. Any of
the three resources listed above would be happy to supply additional information for your use.
The MBTI as a tool for recovering self fits well with Martin and Doka’s (1999) model, which they describe as Patterns of
Grieving. This model suggests it is not male or female differences which create the differing needs of grievers, but the
pattern that is utilized by the griever, male or female: intuitive (feeling/affectively oriented), or instrumental (oriented
toward mastery of oneself and the environment). The MBTI describes patterns of behavior based on psychological
preferences, all of which are normal, but all of which are different from one another. Helping a grief survivor use these
preferences to recover an operational self is to help the griever utilize his/her strengths to recover balance and stability.
Strobe and Shut’s (1999) Dual Process Model is also a good fit for Myers Briggs work. The Dual Process Model suggests
that the bereaved, in the early days of the loss, are oriented more toward emotions that come and go unannounced and
during which time negative affect seems to predominate; however, as time goes on positive affect plays an increasingly
important role. Concurrent with the emotional focus, attention also must be turned toward other stressors and life
changes required by the loss. So, the bereaved are required to address two areas of their current situation: both the loss
and the restoration of their living situation. Strobe and Shut refer to these two requirements as Loss-oriented and
Restoration-oriented. This – in essence – means that one will find it impossible to attend to only issues of feeling; one
must also attend to all the life requirements that the death of a loved one has put on the table. Vice versa, one cannot
ignore feelings to only attend to practical life issues. For instance, Jennifer, who prefers not to deal with financial details,
was required to constrain her feelings and face the practical necessities which her husband’s death required. In effect,
one must “oscillate” between loss orientation and restoration orientation. This is the aspect that is made
understandable in utilizing the MBTI. This can be seen as “psychological stretching” from one’s preference toward one’s
non-preference. One of the most difficult stressors for the bereaved is the need to reach out and encompass the roles
that have been previously handled by the deceased, whether these are managing relationships and households or
managing practical issues of revenue production. Whereas there have been two persons to handle these major agenda
items, there is now only one person to take on both of these major roles.
Chapter 10: The Re-emerging Self
Although there are several models of the grief process, some with five or more stages, a three-stage model tends to fit
the dynamic in the most economical way. The three-stage model is also a widely accepted model in much of the
reviewed literature. The Re-emerging Self is the third stage of this model. The third stage can be identified when the
survivor:
•
•
•
•
•
•
can move the deceased’s possessions without deep pain
can focus on self-development
can focus on self-gratification
can think of self as a single individual
can meet a new day without overwhelming sadness or depression
begins to operate as an independent, functional self
Some examples of the re-emerging self taken from the stories of those reported in this narrative follow.
Jennifer reports there was a day, not too long ago, when she found herself humming as she did her chores. She also
finds herself better able to stay in the house alone…to complete projects of cleaning out files, closets and other areas
that are beginning to seem cluttered. She is wishing to simplify her life.
© 2010 Joan P. Hubbard & Professional Development Resources | www.pdresources.org | #30-49 The Grieving Self | Page 30 of 34
Broyard (2005) as she describes, “the emerging me” in Chapter 9 of this narrative and in her final chapter of Standby
when she relates, “Writing at the beginning of a day is how I have become aware of where I am, where I have been. I am
less caught in false assumptions as words spread out before me. Loss and grief can burrow in and not let go. These
words have kept me breathing, helped me to examine my feelings, and to know these many years later I have lived with
and through the loss, so that now I can distinguish ordinary dissatisfaction and disappointment from grief, and that I can
be freely happy when I’m dancing or with a friend or discovering a butter-hued water lily” (p. 211).
Kathleen O’Hara (2006), whose son was killed in a house invasion while he was attending college, reports “I grew
stronger over time, and, looking back, I see that with each month’s and year’s passage, I changed. I didn’t feel as lost or
alone. The memories of my old life started to form the foundations of the new. I remembered who I was before this all
happened. I was a person who enjoyed the world, liked adventure, and had an optimistic view of life. As I felt these
things return, I felt them tempered by the absolute knowledge that things can change in a moment and to respect what I
had in the present” (p. 196).
Remember the earlier, disorienting, disorganizing period of life referred to as adolescence? During this period of life, we
were required to develop a self to take us forward into maturity. The period of grief over the loss of a loved one throws
us back into the disorientation, and disorganization of having no operational sense of self. The major task of the grief
journey is recreating that operational self, and that task takes time, longer for some than for others. The changes we are
making in our self have to be melded with the foundations of self which have existed for some time.
The answer to the question posed in the Introduction, “How do we assist ourselves and others to fill the deep personal
hole?” is this: We support the bereaved in continuing to live through their grief, and help them in the quest for their
operational self.
For all who have told their stories of their journey through grief, there is an enduring sense of loss. However, as they
come into this third stage of grief, they begin to note not only the changes they have made in themselves through the
process of grief and time, but they are also able to embrace who they were before the loss. This new self, a combination
of both the old and the new has become their operational self. They are now able to look to and consider the future.
The question of how this grief process best proceeds still remains unanswered. There are studies that suggest that
traditional counseling composed of support and emotional disclosure are not particularly useful except for those
suffering from complicated grief. From the numbers of people this could include, we would be well advised to be aware
that we may find these individuals on our professional door-steps. They will require all of our creative energies and our
awareness that without appropriate intervention they can become suicidal or get into a medical or psychological crisis.
I have some professional difference of opinion, or perhaps a different vantage point from that expressed by Strobe et.al.
(2005). I believe that the grieving process can be shortened by working with those suffering from uncomplicated grief in
helping them to reconnect with their individual self. The disorganization and disorientation that all our grievers reported
is more than loneliness, it is suddenly being cut free from the shared identity with their now deceased loved one, and
trying to figure out who they now are in the world. I believe that using a tool such as the MBTI (which could be done in a
group setting), as well as addressing the issues of resilience are tools through which those with uncomplicated grief can
hasten their return to an operational self. As their operational self begins to navigate, they are led back to stable ground
where they recognize the qualities of self that have worked for them prior to their bereavement. Like our grief narrators
they will discover some changes in their self model…it has been altered somewhat as they have reconnected with their
independent identity.
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Resources
AARP (American Association of Retired Persons)
601 E Street, NW | Washington, DC 20049 | (888) 687-2277
www.aarp.org/family/lifeafterloss
American Art Therapy Association, Inc.
225 North Fairfax Street | Alexandria, VA 22304 | (888)-290-0878
E-mail: [email protected] | www.arttherapy.org
American Association for Marriage and Family Therapy
112 South Alfred Street | Alexandria, VA 22304-30061 | (703) 838-9808
www.aamft.org
American Association of Pastoral Counselors
99504-A Lee Highway | Fairfax, VA 22031-2303 | (703) 385-6967
E-mail: [email protected] | www.aapc.org
American Dance Therapy Association
2000 Century Plaza, Suite 108 | 10632 Little Patuxent Parkway | Columbia, MD 21044 | (410) 997-4040
E-mail: [email protected] | www.adta.org
American Hospice Foundation
2120 L Street, NW, Suite 200 | Washington, DC 20037 | (800) 347-1413 or (202) 223-0204
www.hospicefoundation.org
American Music Therapy Association
8455 Colesville Rd., Suite 1000 | Silver Spring, MD 20910 | (301) 589-3300
E-mail: [email protected] | www.musictherapy.org
Association for Death Education and Counseling
111 Deer Lake Road, Suite 100 | Deerfield, IL 60015 | (847) 509-0403
www.adec.org
Association for Psychological Type International (APTi)
9650 Rockville Pike | Bethesda, MD 20814-3998
http://www.aptinternational.org
Center for Application of Psychological Type (CAPT)
2815 NW 13th Street, Suite 401 | Gainesville, FL 32609 | 800-777-2278 or 352-375-0160
http://www.capt.org
Compassionate Friends
P.O. Box 3696 | Oak Brook, IL 60522 | (877) 969-0010 or (630) 990-0010
www.compassionatefriends.org
Consulting Psychologists Press (CPP)
(800) 624-1765
www.cpp.com
© 2010 Joan P. Hubbard & Professional Development Resources | www.pdresources.org | #30-49 The Grieving Self | Page 32 of 34
GriefNet
P.O. Box 3272 Ann Arbor, Michigan | 48106-3272
www.griefnet.org
GriefShare
P. O. 1739 | Wake Forest, NC 27588 | (800) 395-5755
www.griefshare.org
Healing Heart
P.O. Box 56 | Black Diamond WA 98010
www.healingheart.net
National Mental Health Consumers’ Self-Help Clearinghouse
1211 Chestnut St. | Philadelphia, PA 19107 | (800) 553-4539 (215) 751-1810
E-mail: [email protected] | www.mhselfhelp.org
Author Bio:
Joan P. Hubbard, MA, is recently retired (2007) from an active Marriage and Family Therapy practice. Her clinical
practice of 32 years specialized in issues of individuals, couples and family. Toward the latter part of her practice she was
also applying systems work to organizations. She has particular expertise with the Myers-Briggs Type Indicator and has
been on the faculty of the Center for Application of Psychological Type (CAPT) and has served with the Association for
Psychological Type International (APTi) as the Consultant to the area of Counseling and Psychotherapy. In her capacity
with APTi she authored a series of articles on the applicability of the Myers-Briggs Type Indicator to the field of
counseling and psychotherapy.
© 2010 Joan P. Hubbard & Professional Development Resources | www.pdresources.org | #30-49 The Grieving Self | Page 33 of 34
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